Esther J. Cepeda: One weighty issue

By Esther J. Cepeda, Columnist

Saturday, June 29, 2013

Is obesity truly a disease that requires medical treatment and prevention, as the American Medical Association recently proclaimed? Or is it still more accurately a “condition” with too many variables and factors to shoehorn into a neat category?

There are as many opinions on this matter as there are sesame seeds topping the bun of a succulent Big Mac. But if a label with more gravitas is what it’ll take for obesity to be taken seriously, then let’s go with it.

Writing on the “Obesity Panacea” blog of the Public Library of Science (PLOS) website, Travis Saunders, a Ph.D. candidate researching the relationship between sedentary time and the risk of chronic disease in children, says, “It almost seems as though obesity has been medicalized in every way except the one that matters. It has certainly been medicalized in the eyes of the general public.”

With the exception of the AMA, he notes: “However, the fact that the government/medical establishment continue to view obesity ... as a lifestyle problem rather than a genuine disease, has also led to lack of qualified medical support on this issue, as well as evidence-based public health strategies.”

Without dragging you through the minutiae of the standards of medical education in this country, let’s get a few things straight about the pre-”obesity as a disease” state of patient care.

For one, nutrition is a topic that is barely addressed in the already crowded medical school curriculum. A study by the University of North Carolina at Chapel Hill followed up on the scant 25 hours of minimum nutrition education that the National Academy of Sciences established as the standard in the mid-1980s. In 2009 it found that medical students received an average of 19.6 contact hours of nutrition instruction during their medical school careers.

Additionally, study after study has found that primary-care providers don’t spend nearly enough time talking to patients about their weight. In 1998, the National Institutes of Health recommended that health care professionals advise obese patients to lose weight. In 2011, research published in the Archives of Internal Medicine found that of participants in government health surveys, one-third of obese patients and 55 percent of overweight patients said a doctor had never told them they were overweight.

Maybe even worse: neither the medical community nor the patient population has figured out sensible, neutral ways to even approach the topic of obesity in the context of the doctor-patient relationship. Part of this can be blamed on Americans’ need to put self-esteem ahead of health, and some also rests on physicians’ bias and poor people skills.

A national survey published in a fall 2011 edition of the journal Pediatrics found that parents feel blamed and respond badly to words such as “fat,”“obese” and “extremely obese.” Parents said they’d feel more motivated if a doctor said their child had an “unhealthy weight,” a “weight problem,” or a “high BMI” (Body Mass Index).

A study in the June 2013 issue of Preventive Medicine by a team of researchers at the Johns Hopkins University found that overweight and obese patients trust weight-related counseling from overweight physicians more than normal weight physicians.

Surprisingly, though, patients seeing obese primary care physicians -- as compared to normal BMI physicians -- were also significantly more likely to report feeling judged because of their weight. Researchers don’t know why but, either way, many patients get a bad vibe from their doctor -- sometimes with good reason.

Researchers at Johns Hopkins pored over audio-recorded outpatient encounters from 39 urban primary care physicians and 208 of their patients, most of whom were overweight or obese, the journal Obesity reports.

The researchers found that doctors demonstrated less emotional rapport with overweight and obese patients than with normal weight patients, a discovery in line with previous research showing that a majority of health care professionals have lower opinions of overweight patients.

Saunders closed his blog post: “Regardless of whether or not you think that obesity is a disease, there is little doubt that health care professionals receive inadequate training in how to deal with obesity-related issues, and that this has negative consequences for their patients.”

Whether technically accurate or not, we should hope that labeling obesity a disease can at least change how America trains doctors to treat it.